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word hypoglycemia simply means low blood sugar. It’s often used
to suggest a disease but it is actually only one symptom of a
syndrome with many complaints. This complex would be better
defined by the term carbohydrate intolerance. It is
expressed by the body’s inability to use certain carbohydrate
loads effectively without adverse consequences.
consumed, sugar and complex carbohydrates evoke a rise in blood
sugar that triggers insulin release from the pancreas. This
hormone facilitates immediate carbohydrate utilization or
storage in various parts of the body. The liver converts
excesses to fatty acids that are packaged into triglycerides and
transported into fat cells for storage. In hypoglycemics,
insulin release is either excessive, or the cutoff is
inadequate, or insufficiently terminated by counter regulatory
hormones. A system‑wide disturbance is created that results in
one of the endocrine fatigue syndromes we call hypoglycemia.
standard for diagnosis has been the five-hour glucose tolerance
test (GTT). This was designed to document the rise and gradual
fall of blood sugar after carbohydrate consumption. A sugar
solution is administered and blood samples are drawn at various
intervals. The GTT has not been very efficient in detecting the
sudden fall of blood sugar levels that characterize
hypoglycemia. Timing is crucial and with predetermined schedule
for blood draws, the lowest level may be missed. Another problem
was seen in a study done in 1994 by Genter and Ipp on a group of
young, healthy people who had no symptoms of hypoglycemia.1
Blood samples were drawn every ten minutes to measure the amount
and time-release of various hormones that counteract insulin to
prevent an excessive drop in blood sugar. One‑half of the
subjects developed acute symptoms of hypoglycemia near the peak
adrenaline release coinciding with their lowest glucose levels.
However, the symptoms occurred at glucose levels that are
considered normal. Obviously each person has a personal alarm
system, an individual blood sugar level at which the brain
perceives danger and releases adrenaline (epinephrine). For
these reasons, listening to a patient’s symptoms has been more
accurate in making the diagnosis than blood testing.
symptoms of hypoglycemia (a term we continue to use) are many.
First are the chronic symptoms that are experienced even
when the blood sugar is normal. They consist of fatigue,
irritability, nervousness, depression, insomnia, flushing,
impaired memory and concentration. Anxieties are common as are
frontal or bitemporal headaches, dizziness and faintness. There
is often blurring of vision, nasal congestion, ringing in the
ears, numbness and tingling of the hands, feet or face and
sometimes leg or foot cramps. Excessive gas, abdominal cramps,
loose stools or diarrhea are frequent.
acute symptoms are frightening and occur at highly
variable glucose levels, but usually three or four hours after
eating. The release of adrenaline, more than sufficient for
correcting the fallen blood or brain sugar, induces these
distressing twenty-to-thirty minute events. They include hand or
internal shaking accompanied by sweating, especially with
hunger. Heart irregularities or pounding and severe anxiety
completes the picture. The more intense bouts are labeled panic
attacks. Feeling faint is common and actual syncope may occur.
Nocturnal attacks are often preceded by nightmares and cause
severe sleep disturbance resulting in daytime somnolence.
a perfect diet will control hypoglycemia. It is not the food one
adds but what one removes that assures recovery. Patients must
totally avoid sugar, corn syrup, honey, sucrose, glucose,
dextrose or maltose. Heavy
starches such as potatoes, rice and pasta are also
forbidden. We allow one piece of fruit in a four hour period but
no juice since they contain excess fructose. Certain
carbohydrates such as sugar‑free bread are allowed but intake is
limited to one slice three times per day. All carbohydrates are
not created equal as can be seen by our list. You must follow
the diet as written with no substitutions: for example puffed
rice is allowed but not rice. Caffeine is not allowed since it
prolongs the action of insulin.
Improvement begins in about seven to ten days of beginning a
perfect diet. Considerable relief is afforded within one month.
Symptoms totally clear within two months but only if the diet
has been carefully followed. During the first ten days of
treatment, headaches from caffeine withdrawal and the fatigue
induced by changing the body's basic sources of fuel are common
and in some patients can be fairly intense.
Consider the entire dietary process as if one were building a
checking account. First, deposits must be made to obtain
sufficient funds. Only at this point should one begin writing
checks but with the understanding that balances are lowered with
each one written. Similarly, the hypoglycemia diet builds
energy reserves to the highest amount attainable for a given
individual. Only then can carbohydrate experimentation begin.
Each "cheat" draws on the credit line. Since no physician or
dietician can predict the final baseline diet, this hunt and
peck system is necessary for each patient. The first warning of
an excess may be spotted with the reoccurrence of any of the
above hypoglycemia symptoms. A stricter diet may again be
required to rebuild credit, or to meet demands for added energy
at times of emotional or physical stress such as during the week
hypoglycemics also suffer from fibromyalgia. Symptoms overlap
greatly but not the acute ones listed above. Fibromyalgia
is a generalized metabolic disturbance that includes contracted,
working muscles, ligaments and tendons, which constantly burn
fuel. This is the subject of another paper we have written.
Predisposed individuals with fibromyalgia may attempt to create
energy by yielding to their carbohydrate cravings. The
resulting repetitive insulin bursts can tip them into
hypoglycemia. Patients with both conditions are among our
Dietary Restrictions The
Hypoglycemic Must Follow:
HAVE NONE OF THESE:
Alcohol (for one month)
in any form, including soft drinks
juices and dried fruits
Black‑eyed peas (cowpeas)
Garbanzo beans (chickpeas)
(limit popcorn to one cup)
Burritos (flour tortilla)
Caffeine, Dextrose, Maltose, Sucrose, Glucose, Honey, Corn
Syrup, Rice Syrup, Cane Syrup, Fructose, Agave Syrup, Cane
Sweeteners, Brown Rice Syrup.
(NON CALORIC SWEETENERS SUCH AS SUCRALOSE, STEVIA, CYCLAMATE,
SACCHARIN are fine. )
No compromise is allowed with the diet
for the carbohydrate intolerance syndrome.
One must eat correctly or symptoms continue. The reward of
well being is exhilarating when contrasted with the disabling
symptoms of hypoglycemia. It is yours to control.
St. Amand, M.D. Assistant Clinical Professor Medicine Endocrinology‑-Harbor-UCLA
Craig Marek, Medical Assistant
P. and Ipp, E. Metabolism, Vol. 43, No. 1 (January) 1994, pp 98‑103